GALLSTONES IN CRITICALLY ILL PATIENTS WITH ACUTE CALCULOUS CHOLECYSTITIS TREATED BY PERCUTANEOUS CHOLECYSTOSTOMY - NONSURGICAL THERAPEUTIC OPTIONS
GALLSTONES IN CRITICALLY ILL PATIENTS WITH ACUTE CALCULOUS CHOLECYSTITIS TREATED BY PERCUTANEOUS CHOLECYSTOSTOMY - NONSURGICAL THERAPEUTIC OPTIONS
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DOI：
10.2214/ajr.162.5.8165990
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发表时间：
1994-05-01
影响因子：
5
通讯作者：
GAZELLE, GS
中科院分区：
文献类型：
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作者：
BOLAND, GW;LEE, MJ;GAZELLE, GS
OBJECTIVE.急性结石性胆囊炎患者需要清除胆结石（通常是胆囊切除术），因为如果胆结石留在原位，急性胆囊炎可能会复发。本研究的目的是评估非手术技术在急性结石性胆囊炎危重患者经皮胆囊造口术治疗胆囊结石中的作用。26例重症监护室的复杂内科和外科问题的危重患者因急性结石性胆囊炎接受了紧急经皮胆囊造口术。26例患者中有7例随后死于多器官衰竭。在存活的19名患者中尝试了治愈性胆结石治疗，其中7名接受了择期胆囊切除术。19例患者中有12例尝试了非手术治疗，其中6例患有晚期疾病，接受长期胆囊引流治疗，3例接受甲基叔丁基醚溶解结石治疗，2例接受经皮胆囊取石术，1例胆囊结石进入胆总管并在内镜下取出。所有6例尝试长期胆囊引流的晚期疾病患者均获得成功;他们没有再发生胆囊炎。在其他6例接受非手术治疗（经皮胆囊取石术、甲基叔丁基醚溶石术和内镜下取石术）的患者中，有4例成功取出了胆结石，无需进一步治疗。2例经皮治疗失败，行胆囊切除术。对于急性结石性胆囊炎的高危患者应尝试非手术治疗。有些病人可能受益于长期的胆囊导管引流。
OBJECTIVE. Patients with acute calculous cholecystitis require removal of gallstones (generally cholecystectomy), as acute cholecystitis is likely to recur if gallstones are left in situ. The purpose of this study was to assess the role of nonsurgical techniques for treating gallstones in critically ill patients with acute calculous cholecystitis managed by percutaneous cholecystostomy.MATERIALS AND METHODS. Twenty-six critically ill patients with complex medical and surgical problems who were in intensive care units underwent emergent percutaneous cholecystostomy for acute calculous cholecystitis. Seven of the 26 patients subsequently died of multiple organ failure. Curative gallstone therapies were tried in the surviving 19 patients, seven of whom underwent elective surgical cholecystectomy. Nonsurgical management was attempted in 12 of 19 patients, including six with terminal disease who were treated with long-term gallbladder drainage, three who were treated with methyl tert-butyl ether for stone dissolution, two who had percutaneous cholecystolithotomy, and one who had a gallbladder stone that had passed into the common bile duct and was retrieved endoscopically.RESULTS. Long-term gallbladder drainage was successful in all six patients with terminal disease in whom it was attempted; they experienced no further episodes of cholecystitis. In four of the other six patients treated with nonsurgical therapies (percutaneous cholecystolithotomy, stone dissolution with methyl tert-butyl ether, and endoscopic removal), gallstones were successfully removed and no further therapy was required. Percutaneous therapies failed in two patients, who then had cholecystectomy.CONCLUSION. Nonsurgical gallstone therapies should be attempted in high-risk patients with acute calculous cholecystitis. Some patients may benefit form longterm catheter drainage of the gallbladder.